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Congenital diaphragmatic hernia with(out) ECMO: impaired development at 8 years
  1. Marlous J Madderom1,
  2. Leontien Toussaint2,
  3. Monique H M van der Cammen-van Zijp1,2,
  4. Saskia J Gischler1,
  5. René M H Wijnen1,
  6. Dick Tibboel1,
  7. Hanneke IJsselstijn1
  1. 1Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands
  1. Correspondence to Dr Hanneke IJsselstijn, Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center—Sophia Children's Hospital, room Sk 1280; dr. Molewaterplein 60; Rotterdam 3015 GJ, The Netherlands; h.ijsselstijn{at}erasmusmc.nl

Abstract

Objective To evaluate developmental and social-emotional outcomes at 8 years of age for children with congenital diaphragmatic hernia (CDH), treated with or without neonatal extracorporeal membrane oxygenation (ECMO) between January 1999 and December 2003.

Design Cohort study with structural prospective follow-up.

Setting Level III University Hospital.

Patients 35 children (ECMO: n=16; non-ECMO: n=19) were assessed at 8 years of age.

Interventions None.

Main outcome measures Intelligence and motor function. Concentration, behaviour, school performance, competence and health status were also analysed.

Results Mean (SD) intelligence for the ECMO group was 91.7 (19.5) versus 111.6 (20.9) for the non-ECMO group (p=0.015). Motor problems were apparent in 16% of all participants and differed significantly from the norm (p=0.015) without differences between treatment groups. For all participants, problems with concentration (68%, p<0.001) and with behavioural attention (33%, p=0.021) occurred more frequently than in reference groups, with no difference between treatment groups. School performance and competence were not affected.

Conclusions Children with CDH—whether or not treated with neonatal ECMO—are at risk for long-term morbidity especially in the areas of motor function and concentration. Despite their impairment, children with CDH have a well-developed feeling of self-competence.

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